Monthly Archives: January 2015

The Royal College of Anaesthetists calls for joined up care for high risk surgical patients

Anesthesiology_Plastic Surgery_Orthopedic Surgery_Thoracic Surgery-Neurosurgery_Emergency Medicine

 

The Royal College of Anaesthetists (RCoA) shared its vision for the future of perioperative healthcare provision across the UK. Speaking at a stakeholder event, President of the RCoA Dr J-P van Besouw said: “With more than ten million patients undergoing surgery each year in the NHS, approximately 15% of whom are deemed to be high-risk, a care pathway that can harness multi-disciplinary working, reduce variation and improve patient outcomes must be our goal.”

Health experts, including Celia Ingham Clark, Director for Reducing Premature Mortality, NHS England, highlighted the scale of the unmet need for the high-risk surgical patient and the future principles for a more efficient and effective care pathway, at the event attended by a cross section of health bodies.

J-P van Besouw said: “Lowering the rate of avoidable harm – associated with many preventable complications and deaths – will make a significant saving to the NHS annual surgical bill, which at present runs at around GBP16 billion. The College believes that improved perioperative care is an efficient and effective solution.”

The RCoA proposed that care pathways designed around the individual needs of the complex surgical patient and delivered by a multi-disciplinary perioperative care team would mean that patients should receive the most appropriate care possible. Anaesthetists are uniquely positioned to lead such teams and to ensure a better continuum of care for patients, before, during and after surgery. Such an integrated approach should minimise inappropriate care, reduce cancellations, complications and readmissions and ensure quicker recovery and discharge from hospital. Fundamentally patients should receive better quality care, and experience better outcomes at a lower cost.

As well as improved patient centered care, the economic case for change is an important factor to be considered. The NHS Five Year Forward view states that by 2020/21, there could be a mismatch between resources and patient needs of nearly GBP30 billion a year. Demand, efficiency and funding are the key considerations and the evidence would indicate that perioperative medicine would be a cost effective solution through the reduced costs of treating complications.

In driving this agenda the College stated that it intended to work collaboratively with stakeholders in primary care, other colleges, specialties and workforce planners in Health Education England (HEE) and the devolved nations, to develop and commission new standards of patient care, embed continuous data driven quality improvement into the care of surgical patients, and explore solutions to create an appropriate workforce for a sustainable future.

“We do not underestimate the challenges that we face in delivering this agenda,” said J-P van Besouw. “We are asking colleagues, policy makers and commissioners to share this vision and to use the resources that we have developed, including a short animated film [http://www.rcoa.ac.uk/periopmed/animation], to start the conversation on what perioperative practice should look like and to work with us to develop integrated pathways of care, based on the many existing examples of excellent perioperative practice from across the UK.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/288455.php

 

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An alternative for pain control after knee replacement surgery

Orthopedics_Anesthesiology

It’s estimated that more than half of adults in the United States diagnosed with knee osteoarthritis will undergo knee replacement surgery. While improvements in implantable devices and surgical technique has made the procedure highly effective, pain control after surgery remains a common but persistent side effect for patients.

A Henry Ford Hospital study, presented recently at the American Association of Hip and Knee Surgeons meeting in Dallas, found that injecting a newer long-acting numbing medicine called liposomal bupivacaine into the tissue surrounding the knee during surgery may provide a faster recovery and higher patient satisfaction.

“The pain scores for this injection technique averaged about 3/10, which is similar to the pain scores seen with our traditional method,” says Jason Davis, M.D., a Henry Ford West Bloomfield Hospital joint replacement surgeon and the study’s senior author. “Patients had pain relief for up to two days after surgery and better knee function compared with the traditional method.”

It is estimated that the number of total knee replacement surgeries has more than tripled from 1993 to 2009. Arthritisis the most common cause of chronic knee pain and disability. However, a June 2014 study found that 95 percent of knee surgeries are attributed to the epidemic of overweight and obesity in the United States.

During the two-hour knee replacement procedure, the orthopedic surgeon removes the damaged cartilage and bone, and inserts a knee implant to restore the alignment and function of the knee. More than 90 percent of knee replacements are functioning 15 years after surgery, according to the American Academy of Orthopaedic Surgeons.

In the Henry Ford study, 216 patients were evaluated for pain control the first two days after surgery from October 2012 to September 2013. Half of the patients received the traditional pain control method with continuous femoral nerve blockade, in which common numbing medicine is injected into the groin area, blunting the main nerve down the front of the knee. This method uses a pain pump to extend pain control for two days but causes some leg weakness. “Pain control came at the price of weakness and made patients somewhat tentative when walking during their hospital stay,” Dr. Davis says.

The other half of patients received the liposomal bupivacaine injection at the site of the surgery.

Dr. Davis says many patients were able to walk comfortably within hours after surgery.

Dr. Davis says the injection around the knee itself “optimizes pain control early on” without the side effects of the traditional technique. “Function-wise, it was a lot easier for patients to move around more confidently,” he says. “In the past decade, we’ve made major advancements in pain control for knee replacement surgery. This option is a promising, viable one for our patients.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/287423.php